Br J Ophthalmol [JOURNAL]
Sun
200 papers
Comparative recurrence rates of varicella zoster virus and herpes simplex virus keratitis.
Romano D, Herbert R, Somerville T … +3 more , Nardeosingh S, Vakharia A, Kaye SB
Br J Ophthalmol · 2026 Jun · PMID 42270294 · Publisher ↗
PURPOSE: To compare the recurrence rates of herpes simplex virus type 1 (HSV-1) keratitis (HSK) and varicella zoster virus (VZV) keratitis (VZK). METHODS: This was a cohort study of patients attending The Royal Liverpool...
PURPOSE: To compare the recurrence rates of herpes simplex virus type 1 (HSV-1) keratitis (HSK) and varicella zoster virus (VZV) keratitis (VZK). METHODS: This was a cohort study of patients attending The Royal Liverpool University Hospital between January 2015 and September 2021 with virologically confirmed HSK and/or VZK with a follow-up period of 4 years. Patients with VZK were divided into those with and without a history or concurrence of herpes zoster ophthalmicus (HZO). Patients who had samples collected at each subsequent episode of keratitis were included. RESULTS: 1483 patients were included: 1002 (67.5%) with HSV-1, 472 (31.8%) with VZV and 9 (0.6%) with simultaneous HSV-1 and VZV. Of the 472 patients with VZV, 330 (69.9%) had an HZO-associated VZK (aged 62.3±19.4 years) and 142 patients (30.1%) (aged 54.9±19.2 years; p<0.01) an isolated VZK. Virologically confirmed VZK recurrence was uncommon (8/472, 1.7%) and did not differ between HZO-associated and isolated VZK (p=0.70). In contrast, virologically confirmed HSV recurrence occurred in 110/1002 (10.9%). Overall clinical recurrence (PCR positive and negative) was significantly higher in HSK than in VZK (25.1% vs 9.5%, p<0.01). CONCLUSION: Compared with HSK, recurrence of VZK, either virologically confirmed or clinically defined, is very uncommon. A recurrent keratitis in a patient with a history of VZK or HSK may be due to HSV-1 or VZV reactivation.
Update on treatment and prophylaxis of herpes zoster ophthalmicus.
Milligan AL, Larkin F
Br J Ophthalmol · 2026 Jun · PMID 42270293 · Publisher ↗
Herpes zoster ophthalmicus (HZO) is a viral infection that affects the ophthalmic branch of the trigeminal nerve. HZO is potentially sight-threatening, affecting 4%-20% of all zoster cases. The reported incidence of zost...
Herpes zoster ophthalmicus (HZO) is a viral infection that affects the ophthalmic branch of the trigeminal nerve. HZO is potentially sight-threatening, affecting 4%-20% of all zoster cases. The reported incidence of zoster has quadrupled in the past 60 years, affecting approximately 1 million people per year in the USA and 12.2 per 1000 population in those aged >85 years in the UK.The incidence and severity of vision-threatening complications are moderated by prompt antiviral therapy. Valaciclovir has numerous advantages over aciclovir, including superior bioavailability, higher blood antiviral activity, a longer half-life and simpler dosing regimen. Suppressive antivirals are commonly used as secondary prophylaxis following an episode of HZO, but the evidence to support this practice is weak.Varicella zoster virus is the only human herpesvirus for which highly effective vaccines are available. The recombinant zoster vaccine (Shingrix, GlaxoSmithKline) is a highly effective vaccine in preventing zoster, HZO and postherpetic neuralgia, with vaccine effectiveness of 70%-86%, 67%-93% and 76%, respectively. In this update, the current evidence for the prophylaxis and management of HZO, including keratitis, is evaluated.
Exploring the capabilities of three artificial intelligence chatbots in diagnosis and decision-making of age-related macular degeneration.
Duan N, Zhao X, Wu Z … +8 more , Yuan D, Peng S, Cui K, Yu Z, Yang W, Wei W, Chi W, Zhang G
Br J Ophthalmol · 2026 Jun · PMID 42270292 · Publisher ↗
BACKGROUND: Compare the performance of three artificial intelligence (AI) chatbots, including ChatGPT o4-mini, Gemini 2.5 flash and DeepSeek-R1, in diagnosis, treatment suggestion and visual prognosis of age-related macu...
BACKGROUND: Compare the performance of three artificial intelligence (AI) chatbots, including ChatGPT o4-mini, Gemini 2.5 flash and DeepSeek-R1, in diagnosis, treatment suggestion and visual prognosis of age-related macular degeneration (AMD). METHODS: A retrospective study was conducted on 54 participants with AMD from Shenzhen Eye Hospital and Huizhou Third People's Hospital (from January 2024 to June 2025). Each participant was analysed by three AI chatbots and an ophthalmology resident using standardised prompts. The main outcome measures included diagnosis agreement, treatment suggestion and visual prognosis. Global Quality Score (GQS, 1-5) was assessed to evaluate response quality. Statistical analysis was conducted using R (version 4.4.1), with significance set at p<0.05. RESULTS: Diagnosis agreement was 96.3% for ChatGPT o4-mini, 94.4% for Gemini 2.5 flash, 90.7% for DeepSeek-R1 and resident (all p>0.05). Treatment suggestion agreement was 90.7% for Gemini 2.5 flash, 88.9% for ChatGPT o4-mini, DeepSeek-R1 and resident (all p>0.05). Visual prognosis agreement was 66.7% for ChatGPT o4-mini, 48.1% for Gemini 2.5 flash, 40.7% for DeepSeek-R1 and 37.0% for resident. ChatGPT o4-mini significantly outperformed DeepSeek-R1 (p=0.011) and the resident (p=0.006). GQS ratings favoured ChatGPT o4-mini, significantly higher than Gemini 2.5 flash and DeepSeek-R1, but comparable to the resident (all p>0.05). CONCLUSIONS: Three AI chatbots showed strong capabilities in neovascular AMD diagnosis and treatment suggestions, with ChatGPT o4-mini superior in visual prognosis prediction. However, real-world clinical settings require large-scale studies, and integrative use of multiple large language models may improve robustness and clinical reliability.
Evaluating reasoning in multimodal large language models for ophthalmology: a bilingual benchmark study using clinical vignettes and imaging.
Yin H, Zhao K, Shi D … +2 more , Grzybowski A, Jin K
Br J Ophthalmol · 2026 Jun · PMID 42270291 · Publisher ↗
BACKGROUND: Large language models (LLMs) excel in text-based medical exams, but their ability to integrate multimodal data, critical for ophthalmology, is underexplored. This study evaluates vision-language LLMs' accurac...
BACKGROUND: Large language models (LLMs) excel in text-based medical exams, but their ability to integrate multimodal data, critical for ophthalmology, is underexplored. This study evaluates vision-language LLMs' accuracy and reasoning in complex ophthalmic questions. METHODS: We assessed three multimodal LLMs (CLM-V, ChatGPT-5, MiniCPM-V 4.5) on 316 bilingual ophthalmology questions (175 English Basic and Clinical Science Course single-choice, 141 Chinese senior professional title multiple-choice questions) across cornea, uvea, glaucoma, retina and orbit. Each question paired a clinical vignette with an image. Models were tested with reasoning-enabled and reasoning-disabled prompts. Accuracy was measured against reference standards, and reasoning quality was evaluated using automated rubric scoring (accuracy, data synthesis, logic, option analysis, safety) and expert review. Four cases were analysed qualitatively. RESULTS: Reasoning-enabled prompting increased mean artificial intelligence-assisted total scores in the English dataset from 14.97 to 16.07 for CLM-V, 20.77 to 23.97 for ChatGPT-5 and 10.83 to 12.60 for MiniCPM-V 4.5; in the Chinese dataset, the corresponding scores were 9.03 to 10.27, 19.95 to 22.00 and 11.05 to 13.30, respectively. Human evaluation showed substantial inter-rater agreement (κ=0.87) and again ranked ChatGPT-5 highest. Qualitative case analyses illustrated that reasoning-enabled outputs were often more clinically interpretable, although the magnitude of benefit was model-dependent and dataset-dependent. CONCLUSION: Multimodal LLMs demonstrate potential in ophthalmic question-answering, with reasoning-enabled prompting being associated with improved interpretability and, in most settings, numerically higher performance. However, limitations in subspecialty robustness and image interpretation necessitate rigorous reasoning evaluation for safe educational and clinical applications.
Subretinal drusenoid deposits (reticular pseudodrusen) in the general population: a European multicohort study.
Mauschitz MM, Holz FG, Schuster AK … +15 more , Grabitz SD, Jonas JB, Bikbov MM, Kazakbaeva GM, Hogg R, Peto T, Creuzot-Garcher CP, Gabrielle PH, Coimbra R, Farinha C, Delcourt C, Cougnard-Grégoire A, Brandl C, Heid IM, Finger RP
Br J Ophthalmol · 2026 Jun · PMID 42259595 · Publisher ↗
BACKGROUND/AIMS: To investigate the prevalence and determinants of subretinal drusenoid deposits (SDDs; also known as reticular pseudodrusen, RPDs) in the European general population. METHODS: Altogether 18 931 adults fr...
BACKGROUND/AIMS: To investigate the prevalence and determinants of subretinal drusenoid deposits (SDDs; also known as reticular pseudodrusen, RPDs) in the European general population. METHODS: Altogether 18 931 adults from eight population-based studies were included. SDDs/RPDs were determined on optical coherence tomography and/or infrared photography. The prevalence of SDDs/RPDs and associated ocular and systemic determinants using multivariable logistic regression modelling per study and pooled results using random effects meta-analysis were analysed. RESULTS: Mean age ranged from 58.7±10.6 to 88.4±0.0 years in the different studies and prevalence of SDDs/RPDs ranged from 0.6% to 56.0%. Meta-analyses showed that increasing age (OR 1.09 per year, 95% CI 1.04 to 1.13; p<0.001), prevalent early/intermediate and late age-related macular degeneration (AMD) (OR 10.93, 95% CI 5.55 to 21.51; p<0.001 and OR 11.65, 95% CI 4.78 to 28.40; p<0.001, respectively) and AMD genetic risk score (OR 1.21 per unit, 95% CI 1.05 to 1.39; p=0.008) are associated with prevalent SDDs/RPDs. Sex, smoking, education and cardiovascular disease showed borderline association at some cohort levels but not in the meta-analysis. In sensitivity analyses, only age and AMD genetic risk score remained associated with SDDs/RPDs prevalence among participants without any AMD. CONCLUSIONS: This multi-cohort analysis emphasises the wide range of SDDs/RPDs prevalence and determinants. Besides age, presence of AMD and AMD genetic risk variants increase the risk of SDDs/RPDs. These cross-sectional findings are compatible with the hypothesis that SDDs/RPDs may not represent a separate disease entity but be an additional sign of retinal pigment epithelium and photoreceptor stress.
12-month outcomes of photobiomodulation in dry age-related macular degeneration: a prospective multicentre randomised double-masked controlled clinical trial.
Iovino C, Borrelli E, Coco G … +21 more , Viggiano P, Boscia F, Hasanreisoglu M, Kesim C, Demirel S, Yanık Ö, Lucisano A, Scorcia V, Vagge A, Nicolò M, Proietti S, Bernabei F, Rothschild PR, Farrant S, Ricardi F, Pellegrini M, Mura M, Cartabellotta A, Giannaccare G, Reibaldi M, Carnevali A
Br J Ophthalmol · 2026 Jun · PMID 42259594 · Publisher ↗
BACKGROUND: Dry age-related macular degeneration (dAMD) is the leading cause of irreversible vision loss in older adults, with no approved treatment to modify progression in early and intermediate stages. Photobiomodulat...
BACKGROUND: Dry age-related macular degeneration (dAMD) is the leading cause of irreversible vision loss in older adults, with no approved treatment to modify progression in early and intermediate stages. Photobiomodulation (PBM), which targets mitochondrial dysfunction and retinal inflammation, has shown promise in early studies. This study aims to evaluate the anatomical and functional efficacy of PBM in eyes with early and intermediate dAMD. METHODS: In this 12-month, multicentre, randomised double-masked controlled trial, 138 eyes from 78 patients with early or intermediate dAMD were included. The primary outcome was change in mean drusen volume (MDV) from baseline to 12 months. Secondary outcomes included change in best-corrected visual acuity (BCVA) and adverse events. Multilevel mixed-effects regression was used to analyse treatment-time interactions. RESULTS: MDV decreased significantly in the PBM group (-0.03±0.05 mm³) while increased in the sham group (+0.02 ± 0.04 mm³; p<0.001) at 12 months. The PBM group also showed a significant improvement in BCVA (+1.31 ± 6.7 letters) compared with a decline in the sham group (-2.62±7.1 letters), yielding a between-group difference of +3.75 letters (95% CI 1.16 to 6.34; p=0.0001). Female sex and higher Age-Related Eye Disease Study (AREDS) category were associated with MDV increase over time (p=0.030 and p=0.003; respectively), while older age was associated with MDV reduction (p=0.049). Four eyes in the sham group developed macular neovascularisation, compared with none in the PBM group (p=0.044), while one eye in the PBM group developed geographic atrophy (p=1.00). No cases of retinal phototoxicity were observed. CONCLUSION: PBM significantly reduced drusen burden and improved visual function in early and intermediate dAMD over 12 months, with an excellent safety profile. These findings support PBM as a promising therapeutic option for patients with non-neovascular age-related macular degeneration, despite further studies with longer follow-up are needed to confirm the role of PBM in potentially slowing the natural course of the disease.
Proactive treatment regimen with dexamethasone implant for diabetic and post-occlusive macular oedema: the ProDEX-2 study.
Viggiano P, Peto T, Pignataro M … +10 more , Termite AC, Boscia G, Grassi MO, Malerba MG, Evangelista F, Mavaddati S, Dore S, Alessio G, Vujosevic S, Boscia F
Br J Ophthalmol · 2026 Jun · PMID 42248659 · Publisher ↗
PURPOSE: To evaluate the efficacy of proactive treatment with intravitreal dexamethasone implant (DEX-implant) at fixed 4-month intervals in treatment-naïve patients with diabetic macular oedema (DMO) and retinal vein oc...
PURPOSE: To evaluate the efficacy of proactive treatment with intravitreal dexamethasone implant (DEX-implant) at fixed 4-month intervals in treatment-naïve patients with diabetic macular oedema (DMO) and retinal vein occlusion (RVO), stratified by baseline visual acuity. METHODS: Sixty-one treatment-naïve eyes (35 DMO, 26 RVO) received DEX-implant at 4-month intervals with possible adjustment (3.5-4.5 months) based on anatomical response. Patients were stratified by baseline visual acuity (<55 vs ≥55 Early Treatment Diabetic Retinopathy Study (ETDRS) letters). Main outcomes included changes in visual acuity, central subfield retinal thickness (CST), macular oedema recurrence rates and OCT qualitative parameters at 12 months. RESULTS: Mean visual acuity improved from 51.9±21.1 to 57.8±15.7 ETDRS letters at month 12 (p<0.001). Patients with lower baseline visual acuity showed greater improvement (+8.5±7.8 letters) compared with those with higher baseline acuity (+2.7±6.1 letters, p=0.004). Mean CST decreased from 549.5±196.4 µm to 388.0±158.7 µm (p<0.001). At month 12, 47.5% of eyes maintained optimal or excellent anatomical response, allowing standard or extended intervals. The proactive approach prevented visual acuity and CST fluctuations. Multivariate analysis identified baseline hyperreflective foci count as the strongest positive predictor of visual improvement (β=0.24, p<0.001), while older age was negatively associated (β=-0.14 per 10 years, p=0.018). CONCLUSIONS: Proactive treatment with DEX-implant provided significant functional and anatomical improvements in treatment-naïve DMO and RVO patients while preventing deleterious visual acuity and CST fluctuations. Patients with lower baseline visual acuity and higher hyper-reflective foci count demonstrate greater potential for improvement, supporting this approach as an effective strategy, particularly in these subgroups.
Repeatability of cone photoreceptor metrics with a commercial adaptive optics scanning laser ophthalmoscopy (Mona II) in healthy adults.
Jia J, Du B, Rong H … +4 more , Wang B, Pazo EE, Liu G, Wei R
Br J Ophthalmol · 2026 Jun · PMID 42248658 · Publisher ↗
PURPOSE: To evaluate the repeatability of the adaptive optics scanning laser ophthalmoscopy (AO-SLO) system (Mona II) in measuring cone photoreceptor parameters and compare repeatability differences in different retinal...
PURPOSE: To evaluate the repeatability of the adaptive optics scanning laser ophthalmoscopy (AO-SLO) system (Mona II) in measuring cone photoreceptor parameters and compare repeatability differences in different retinal regions. METHODS: A total of 126 healthy adults aged between 18 and 36 years with cycloplegic spherical equivalent refraction ≤+0.50 D and >-6.00 D were enrolled. Retinal images were captured at the macular fovea centre (0°, 0°), the temporal, nasal, superior and inferior regions at 1.5° and 3.0° eccentricity. At each region, multiple 2.4°×2.4° images were sequentially captured with 0.9°×2.4° overlap between adjacent regions, covering the detection area within 4.2° centred on the fovea. Three images with clear cone photoreceptors and image quality scores of 0.8 or above were selected from each region for analysis. RESULTS: All parameters of the cone photoreceptors demonstrated excellent repeatability, with intraclass correlation coefficient (ICC) ranging from 0.967 to 0.994. The cone density exhibited good repeatability, with the fovea and the nasal region at 1.5° eccentricity showing the highest ICC (0.992). For the cone spacing, regularity and dispersion also demonstrated high repeatability across all regions (all ICC >0.90). CONCLUSIONS: The Mona II AO-SLO system showed high repeatability in measuring parameters of cone photoreceptors in healthy adults, with consistent performance across retinal area within a 4.2° range. TRIAL REGISTRATION NUMBER: ChiCTR2500114249.
Quantification of retinal non-perfusion in eyes with diabetic retinopathy to study the association with retinal neovascularisation: INSPIRED study report 3.
Khalid H, Tsai WS, Lamanna F … +4 more , Riotto E, Gurudas S, Roch L, Sivaprasad S
Br J Ophthalmol · 2026 Jun · PMID 42242891 · Publisher ↗
BACKGROUND/AIMS: To characterise the distribution of retinal non-perfusion and its relationship with neovascularisation elsewhere (NVE) and visual acuity (VA) in referable diabetic retinopathy (DR) using ultra-widefield...
BACKGROUND/AIMS: To characterise the distribution of retinal non-perfusion and its relationship with neovascularisation elsewhere (NVE) and visual acuity (VA) in referable diabetic retinopathy (DR) using ultra-widefield fluorescein angiography (UWFA). METHODS: Eyes with treatment-naïve moderately severe non-proliferative DR (NPDR) to proliferative diabetic retinopathy (PDR) (Diabetic Retinopathy Severity Scale (DRSS) level 43-60) with available UWFA were included in this study. Total and zonal non-perfusion and NVE area were manually delineated across concentric zones (central 1-10 mm, extended posterior >10-20 mm and mid-peripheral >20-30 mm diameter). The Non-Perfusion Index (NPI) was calculated as the ratio of non-perfused area to total area per zone. Associations between NPI, NVE, DR severity and best-recorded VA (BRVA) were assessed. RESULTS: A total of 133 eyes (60.9% NPDR, 39.1% PDR) were analysed. The highest NPI occurred in the mid-periphery (20-30 mm) and posterior pole (15-20 mm) zones, with nasal preponderance. NVE was most frequently observed in the posterior pole (66%) and nasal quadrants. Central and mid-peripheral NPI correlated with NVE area in corresponding zones, showing quadrant-specific associations. Receiver operating characteristic analysis identified a total NPI threshold of 0.23 to differentiate PDR from NPDR (area under the curve=0.798), with the lowest threshold in the superior quadrant. Neither NPI nor NVE area correlated with BRVA. CONCLUSION: NVE represents a localised response to adjacent ischaemia predominantly affecting the nasal and extended posterior retina. NPI threshold of 0.23 distinguishes proliferative from non-proliferative stages, with the superior quadrant showing greater susceptibility to NVE at lower ischaemic levels. No significant correlation found between NPI, NVE area and visual acuity.
AI-based oculomics for trajectory-driven risk stratification of pathologic myopia in paediatric high myopia.
Zhu Z, Li H, Xiong R … +5 more , Tan S, Zeng S, Chen S, He M, Wang W
Br J Ophthalmol · 2026 Jun · PMID 42242890 · Publisher ↗
AIMS: To identify early oculomic biomarkers predictive of pathologic myopia (PM) in children with high myopia (HM) and to develop an artificial intelligence (AI)-based model for individualised risk stratification. METHOD...
AIMS: To identify early oculomic biomarkers predictive of pathologic myopia (PM) in children with high myopia (HM) and to develop an artificial intelligence (AI)-based model for individualised risk stratification. METHODS: This prospective longitudinal study included 375 children with bilateral HM (spherical equivalent ≤ -6.00 dioptres (D)) from the Zhongshan High Myopia Cohort, followed for a median of 15.0 years (IQR, 14.9-15.4; range, 14.7-15.7). Deep learning-based automated retinal vascular phenotyping was applied to fundus photographs and integrated with longitudinal ocular biometry and swept-source optical coherence tomography metrics. Multivariable models identified independent predictors of PM onset and predictive performance was assessed using area under the receiver operating characteristic curve (AUROC). A web-based prediction tool was developed for clinical deployment. RESULTS: PM developed in 64 children (17.1%). Independent predictors included lower retinal vessel density (OR, 9.69; 95% CI 4.33 to 21.70), reduced fractal dimension (OR, 5.94; 95% CI 3.07 to 11.50), narrower arteriolar and venular calibres (central retinal arteriolar equivalent: OR, 3.44; 95% CI 1.86 to 6.34; central retinal venular equivalent: OR, 4.42; 95% CI 2.24 to 8.71), thinner subfoveal choroid (OR, 2.64; 95% CI 1.56 to 4.45), faster early axial elongation (OR, 1.72; 95% CI 1.17 to 2.50) and accelerated early choroidal thinning (OR, 2.33; 95% CI 1.41 to 3.84). The AI oculomic model achieved excellent discrimination (AUROC, 0.96; 95% CI 0.92 to 1.00), improving to 0.98 (95% CI 0.95 to 1.00) with biometric variables. These predictors were implemented in a publicly accessible risk prediction platform (System for Myopia AI-based Risk Tracking-PM). CONCLUSIONS: PM risk in paediatric HM is detectable early through retinal microvascular architecture and ocular growth dynamics. AI-enabled oculomic profiling offers a scalable approach to early risk stratification, supporting targeted surveillance and timely prevention of sight-threatening pathology.
Clinical efficacy and safety of aflibercept biosimilars in neovascular age-related macular degeneration: a systematic review and meta-analysis of randomised controlled trials.
Zhang C, Sonik NR, Ayoubi M … +5 more , AbouKasm G, Zhu D, Fan JC, Albini TA, Yannuzzi NA
Br J Ophthalmol · 2026 Jun · PMID 42236129 · Publisher ↗
BACKGROUND: To evaluate the efficacy and safety of aflibercept biosimilars compared with reference aflibercept in the treatment of neovascular age-related macular degeneration (nAMD). METHODS: A systematic review and met...
BACKGROUND: To evaluate the efficacy and safety of aflibercept biosimilars compared with reference aflibercept in the treatment of neovascular age-related macular degeneration (nAMD). METHODS: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on PROSPERO (CRD4201069147). Phase 3 randomised controlled trials (RCTs) comparing aflibercept biosimilars to reference aflibercept in treatment-naïve nAMD were included. All included studies employed a standardised on-label aflibercept dosing regimen consisting of three initial monthly loading doses followed by injections every 8 weeks. The primary outcome was the mean difference (MD) in best-corrected visual acuity (BCVA) at week 8. Secondary outcomes included BCVA at week 52, proportion of patients gaining ≥15 letters or maintaining vision (<15-letter loss), central subfield thickness (CST) and adverse events (AEs). RESULTS: Six RCTs (2022-2024) were included, comprising 2029 eyes (1020 biosimilar; 1009 reference). BCVA at week 8 did not differ significantly between groups (MD -0.34 letters; 95% CI -1.12 to 0.44; I²=0%; p=0.39), as was BCVA at week 52 (MD -0.04; 95% CI -1.18 to 1.10; I²=1%; p=0.94). No differences were observed in the proportion of patients gaining ≥15 letters, maintaining vision, CST changes or AEs. CONCLUSIONS: Aflibercept biosimilars demonstrated no significant difference in efficacy at 8 weeks and 52 weeks as well as safety relative to reference aflibercept in eyes with treatment-naïve nAMD following an on-label aflibercept treatment protocol; however, real-world extended durability remains untested. These findings were supported by a low risk of bias and a high-certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations tool.
Trends of blindness and visual impairment in individuals aged 70 and older.
Guo X, Chen Y, Yao J … +6 more , Huang J, Xiong R, Han X, Huang W, Congdon N, Wang W
Br J Ophthalmol · 2026 May · PMID 42215276 · Publisher ↗
BACKGROUND: The global ageing population has heightened the importance of eye health, yet comprehensive assessments of blindness and vision impairment (BVI) burden among older adults remain limited. Using Global Burden o...
BACKGROUND: The global ageing population has heightened the importance of eye health, yet comprehensive assessments of blindness and vision impairment (BVI) burden among older adults remain limited. Using Global Burden of Disease 2021 data, we analysed trends and disparities in BVI and major eye diseases across 204 countries and territories from 1990 to 2021 among adults aged ≥70 years. METHODS: Age-standardised prevalence (ASPR), years lived with disability, and average annual percentage change (AAPC) were estimated for BVI and its leading causes, stratified by age, sex, region and Sociodemographic Index (SDI). Temporal trends were assessed using joinpoint regression. RESULTS: Globally, between 1990 and 2021, the number of BVI cases increased 156% (94.5 to 242 million) with an AAPC of 0.11%. Women experienced a faster rise in ASPR than men (AAPC 0.16% vs 0.11%). Age-specific analysis revealed divergent trends: prevalence rose in the 70-84 age group (peak AAPC 1.02% in 70-74 years) but declined in those ≥85 years (AAPC -0.23% in 85-89 years). With increasing SDI, the prevalence rate for BVI and major blinding eye diseases significantly decreased (p<0.001). Regionally, high-income North America showed the largest ASPR reductions (AAPC -0.30%). CONCLUSIONS: Demographic expansion and ageing are the primary drivers of the rise in absolute BVI burden among adults aged ≥70 years since 1990, with persistent inequities across sex and SDI levels. Further country-specific analyses, particularly in settings with limited primary data, will help refine estimates and support future research and service planning.
Glycoprotein B genotypes and clinical features in patients with recurrent cytomegalovirus anterior segment infection.
Hsu HT, Huang CY, Hwang YS … +1 more , Hsiao CH
Br J Ophthalmol · 2026 May · PMID 42215275 · Publisher ↗
BACKGROUND/AIMS: To investigate glycoprotein B (gB) genotypes of cytomegalovirus (CMV) in patients with recurrent anterior segment infections and evaluate their clinical characteristics. METHODS: This retrospective study...
BACKGROUND/AIMS: To investigate glycoprotein B (gB) genotypes of cytomegalovirus (CMV) in patients with recurrent anterior segment infections and evaluate their clinical characteristics. METHODS: This retrospective study included 11 patients with recurrent CMV anterior segment infection in whom CMV DNA was detectable by aqueous polymerase chain reaction (PCR) at both initial presentation and recurrence. The aqueous humour samples at initial presentation and recurrence were analysed for gB genotyping using a nested multiplex PCR protocol. Clinical features and outcomes were compared between patients with recurrence due to reactivation of initially predominant strains and those with emergence of additional strains. RESULTS: Initially, all 11 patients harboured CMV gB1 and/or gB3 genotypes-predominant strains-either alone or in combination with other minor strains. On recurrence, all patients showed reactivation of predominant strains; two exhibited identical strains, two retained predominant strains but lost some strains and seven acquired new strains in addition to predominant ones. Recurrence occurred following discontinuation or tapering of antiviral therapy, with over 90% of patients receiving corticosteroids concurrently. Most patients developed elevated intraocular pressure and corneal endothelial cell loss; one required trabeculectomy and five underwent corneal transplantation during follow-up. Patients with reactivation involving both predominant and new strains were significantly older (68.3 vs 56.3 years, p=0.04), with comparable clinical outcomes between groups. CONCLUSION: Recurrent CMV anterior segment infection primarily results from reactivation of predominant strains, underscoring the need for extended antiviral maintenance treatment. In elderly patients with late recurrences, reinfection with new strains should be considered.
Trends in 18 years of keratoplasty in Europe: insights from the European Eye Bank Association's data.
Kuklinski MW, Armitage WJ, Böhringer D … +7 more , Claerhout I, Dekaris I, Gareiss-Lok A, Hjortdal J, Jones G, Ponzin D, Maier P
Br J Ophthalmol · 2026 May · PMID 42215274 · Publisher ↗
BACKGROUND/AIMS: To examine trends in corneal transplantation in Europe over an 18-year period from 2007 to 2024 by using data from the annual reports of the European Eye Bank Association (EEBA) regarding transplantation...
BACKGROUND/AIMS: To examine trends in corneal transplantation in Europe over an 18-year period from 2007 to 2024 by using data from the annual reports of the European Eye Bank Association (EEBA) regarding transplantation procedure type and quality control parameters in eye banking. METHODS: Data were extracted from annual EEBA reports, and a longitudinal analysis of the categories-type of transplant, storage methods, issuance and contamination rates was conducted. RESULTS: The analysis included 443 237 corneas issued for transplantation from 116 different eye banks across 25 countries. The total number of keratoplasty procedures grew by 108%. A shift towards lamellar procedures was noted. Penetrating keratoplasties decreased from 85% (2007) to 34% (2017). A significant increase in posterior lamellar grafts was seen, reaching 47% in 2017, which were increasingly produced in eye banks. Issuance rates improved over time, with 59% of procured corneas issued for transplantation in 2024. Contamination rates remained low at 1-2% for bacterial and 0.3 to 0.96% for fungal contamination. Comparison with other international studies confirms the observed trend favouring lamellar procedures, while countries with differing socioeconomic conditions deviate from this trend. CONCLUSION: This study provides a comprehensive overview of the shifting landscape of corneal transplantation in Europe, reflecting a move towards lamellar procedures and bank-prepared transplants. These findings align with broader international trends, underscoring the importance of continued advancements in surgical techniques and eye banking practices. Low contamination rates are indicative of already successful procedures in eye banking in Europe, and reports of lower rates warrant further investigation and improvement.
Mitomycin C-based angio-regression for corneal neovascularisation: outcomes with intravascular (MICE), intrastromal (MIST) and combined delivery routes.
Milligan AL, Day AC, Koay SY … +3 more , Wilkins M, Maurino V, Watson M
Br J Ophthalmol · 2026 Jun · PMID 42215273 · Publisher ↗
BACKGROUND: Corneal neovascularisation (NV) is a refractory condition associated with lipid deposition, scarring and vision loss. Mitomycin C (MMC) intravascular chemoembolisation (MICE) has shown early promise but real-...
BACKGROUND: Corneal neovascularisation (NV) is a refractory condition associated with lipid deposition, scarring and vision loss. Mitomycin C (MMC) intravascular chemoembolisation (MICE) has shown early promise but real-world data remain limited. This study evaluates the efficacy and safety of MICE and MMC intrastromal injection (MIST). METHODS: Retrospective case series of patients with corneal NV treated with MICE and/or MIST at Moorfields Eye Hospital between March 2023 and March 2025. NV regression was assessed using (1) ImageJ quantitative analysis, (2) masked independent grading of slit-lamp photographs and (3) surgeon-reported outcomes. Corrected distance visual acuity and complications were recorded. RESULTS: 39 procedures were performed; median follow-up was 12 months. MIST alone was performed in 70% as intravascular cannulation was achieved in only 15%. NV regression was demonstrated in 59% by ImageJ analysis, 71% by independent grading and 81% by surgeon-reported outcomes. Four patients subsequently underwent successful keratoplasty without NV recurrence. Most complications were mild and self-limiting. Two serious complications involving anterior chamber MMC migration occurred in eyes with significant corneal thinning or prior perforation. CONCLUSIONS: In the largest cohort reported to date, MICE and MIST represent effective angio-regressive strategies for refractory corneal NV. MIST alone produces meaningful vascular regression, offering a more accessible surgical approach. MMC-based angio-regression appears to be the most effective treatment currently available and may have an important role in stabilising high-risk corneas prior to keratoplasty.
Visual loss in high myopia without pathologic myopia: a 5-year longitudinal study on the role of Choroidal Vascularity Index.
Crincoli E, Carlà MM, Catania F … +7 more , Giannuzzi F, Savastano MC, Campaniello G, Mottola F, Rizzo C, Bacherini D, Rizzo S
Br J Ophthalmol · 2026 May · PMID 42185034 · Publisher ↗
BACKGROUND: To determine whether a progressive reduction in Choroidal Vascularity Index (ΔCVI) is independently associated with unexplained visual loss (UVL) in highly myopic (HM) eyes without pathologic myopia (PM), and...
BACKGROUND: To determine whether a progressive reduction in Choroidal Vascularity Index (ΔCVI) is independently associated with unexplained visual loss (UVL) in highly myopic (HM) eyes without pathologic myopia (PM), and to evaluate the predictive utility of baseline CVI as a structural biomarker. METHODS: This longitudinal study included 126 HM eyes (axial length ≥26.0 mm or SE ≤-6.00 D) without PM and with ≥5 years of optical coherence tomography (OCT) follow-up, including 35 eyes with UVL-defined as ≥0.1 logarithm of the minimum angle of resolution best-corrected visual acuity loss in the absence of new anatomical, refractive or media-related changes- and 91 control eyes with stable vision. A 1:2 propensity score analysis was performed matching 32 eyes from UVL group and 62 control eyes. CVI was computed from subfoveal OCT B-scans acquired with Heidelberg Spectralis at baseline and at 60 months. ΔCVI was defined as the difference between follow-up and baseline. Multivariate logistic regression and ROC analyses were performed on the whole cohort to identify independent predictors of UVL. RESULTS: ΔCVI was significantly greater in UVL eyes (mean -1.87%) than in controls (-0.61%, p < 10⁻¹³). Baseline CVI did not differ significantly after matching (p = 0.12). In multivariate analysis, ΔCVI emerged as the strongest predictor of UVL (OR=10.4 per 1% CVI decrease; p < 0.001), with an area under the curve (AUC) of 0.90 and a Youden index of 0.66. In contrast, baseline CVI had poor predictive power (AUC=0.69) and did not improve model performance when added. CONCLUSIONS: Longitudinal reduction in CVI, but not baseline CVI, is strongly associated with UVL in HM eyes without PM. ΔCVI may represent an early biomarker of functional decline before visible macular damage.
Normative axial length growth references in preterm and term infants for clinical use in early onset glaucoma.
Kaushik S, Dhariwal P, Verma P … +7 more , Kaushik R, Katoch D, Sukhija J, Kaur S, Singh M, Thattaruthody F, Pandav SS
Br J Ophthalmol · 2026 May · PMID 42185033 · Publisher ↗
PURPOSE: To establish normative axial length growth references for preterm infants without retinopathy of prematurity (ROP) and term-born children under 5 years and construct templates to aid early-onset glaucoma evaluat...
PURPOSE: To establish normative axial length growth references for preterm infants without retinopathy of prematurity (ROP) and term-born children under 5 years and construct templates to aid early-onset glaucoma evaluation and monitoring. METHODS: In this prospective cross-sectional study, preterm infants (<37 weeks' gestational age) without ROP and healthy term-born children under 5 years were included. Axial length was measured using ultrasonic biometry. Growth references were plotted on logarithmic scales: postmenstrual age (PMA) for preterm infants, months for term children. Analysis of covariance compared the growth slopes. Multiple linear regression assessed predictors of axial length growth (gestational age, measurement age and birth weight). RESULTS: 220 eyes (101 term, 119 preterm) were analysed. The mean gestational age was 39.5±0.84 weeks in term and 31.8±2.17 weeks in preterm infants. The mean axial length was 21.15±1.6 mm in term and 16.95±1.15 mm in preterm infants at 17.3±13.2 months and 43.5±5.9 weeks PMA, respectively. In preterm infants, PMA and birth weight showed a strong independent positive association with axial length. In term infants, only PMA showed a strongly independent positive association with axial length. Collinearity diagnostics indicated no evidence of significant multicollinearity in either group. Preterm eyes had a steeper slope compared with term eyes (0.16 vs 0.02). CONCLUSIONS: The steeper axial elongation in preterm infants may represent compensatory postnatal growth and is clinically important for the assessment of glaucoma in the preterm period. The derived growth references offer practical clinical tools for distinguishing physiological ocular growth from pathological enlargement due to elevated intraocular pressure in neonatal-onset glaucoma.
Prevalence and risk factors associated with corneal opacity in The Gambia.
Erima D, Taylor EH, Okoh JA … +11 more , Olaniyan SI, Bell SJ, Kirkpatrick B, Bobat H, Bascaran C, Cassels-Brown A, Faal H, Kim MJ, Mactaggart I, Hydara A, Burton MJ
Br J Ophthalmol · 2026 May · PMID 42156161 · Publisher ↗
BACKGROUND/AIMS: Corneal opacity (CO) is a significant cause of vision impairment and blindness worldwide. The first National Eye Health Survey in The Gambia (1986) and follow-up (1996) showed a decline in the crude prev...
BACKGROUND/AIMS: Corneal opacity (CO) is a significant cause of vision impairment and blindness worldwide. The first National Eye Health Survey in The Gambia (1986) and follow-up (1996) showed a decline in the crude prevalence of blindness but an increase in blindness from non-trachomatous CO. This study aimed to provide an update on the prevalence of CO and identify associated risk factors. METHODS: Multi-stage stratified cluster random sampling was used to select a nationally representative sample of 10 800 adults aged ≥35 years. Distance best-corrected visual acuity was assessed with Peek Acuity. Ophthalmologists examined participants to identify trachomatous trichiasis, pterygium, CO, corneal ulcers and band keratopathy. CO was graded using a previously described system. Counts and prevalence estimates were based on the weighted sample, corrected for age/sex imbalance. The main outcome was the prevalence of CO. Multivariable logistic regression identified risk factors associated with CO. RESULTS: 9188 participants were examined. CO was found in one or both eyes in 878 participants, giving an age-sex-adjusted prevalence of 9.6% (95% CI 8.7 to 10.5). CO was more likely unilateral (n=673) than bilateral (n=205). Among affected eyes, 41.0% had moderate or severe vision impairment or blindness. Risk factors independently associated with CO included trachomatous trichiasis (OR 5.22 [95% CI 3.46 to 7.86]), older age (OR 4.06 [95% CI 2.54 to 6.47]), male sex (OR 1.58 [95% CI 1.34 to 1.86]) and rural residence (OR 1.62 [95% CI 1.15 to 2.28]). CONCLUSION: The prevalence of CO in The Gambia remains high. Focused national efforts to prevent and treat CO are urgently needed.
Postacute sequelae of SARS-CoV-2 infection on ophthalmic diseases: a binational cohort study.
Yang JM, Lee H, Park J … +7 more , Kim M, Sa HS, Lee JY, Sung KR, Branda F, Acharya KP, Yon DK
Br J Ophthalmol · 2026 May · PMID 42150854 · Publisher ↗
BACKGROUND: Although health problems may persist beyond 4 weeks after SARS-CoV-2 infection, evidence on long-term ophthalmic sequelae is limited. We conducted a binational, population-based cohort study to evaluate the a...
BACKGROUND: Although health problems may persist beyond 4 weeks after SARS-CoV-2 infection, evidence on long-term ophthalmic sequelae is limited. We conducted a binational, population-based cohort study to evaluate the association between postacute sequelae of SARS-CoV-2 infection and the risk of multiple ophthalmic diseases. METHODS: Data were collected from two large cohorts: South Korea (discovery cohort; n=15,992,761) and Japan (validation cohort; n=12,218,680), including individuals aged ≥20 years who were infected with SARS-CoV-2. Cox proportional hazards models with propensity score-based overlap weighting were used to estimate HRs, with analyses stratified by COVID-19 severity and SARS-CoV-2 variant period. RESULTS: In the overlap-weighted discovery cohort, 4 041 250 individuals (mean age 52.52 years (SD 11.52); 59.1% male) were included. SARS-CoV-2 infection was associated with a long-term increased risk of any ophthalmic disease (HR, 1.23 (95% CI, 1.22-1.25)). Elevated risks were observed for glaucoma (1.21 (1.19-1.23)), cornea and conjunctiva diseases (1.22 (1.21-1.23)), blepharitis (1.19 (1.17-1.22)), retinopathy (1.17 (1.15-1.18)), uveitis (1.11 (1.01-1.22)) and neuro-ophthalmic diseases (1.11 (1.06-1.15)). The risk of ophthalmic diseases gradually attenuated over time after SARS-CoV-2 infection. The risk was more pronounced among individuals with severe COVID-19. The associations between SARS-CoV-2 infection and the risk of ophthalmic diseases were generally consistent across the pre-Delta, Delta and Omicron eras. Similar patterns were consistently observed in the validation cohort. CONCLUSIONS: Our findings suggest an increased risk of postacute ophthalmic sequelae following SARS-CoV-2 infection, underscoring the need for sustained clinical vigilance across a broad range of ophthalmic conditions.
Risk factors associated with myopia onset in pre-myopic children aged 5-9 years old: ATOM3.
Loh KL, Burkill S, Saw SM … +1 more , Chia A
Br J Ophthalmol · 2026 May · PMID 42150853 · Publisher ↗
AIM: Identification of risk factors associated with incident myopia at 1 and 2 years in eyes of young pre-myopic children. METHODS: 150 eyes of 75 placebo-treated pre-myopic children (spherical equivalent (SER) -0.49 to...
AIM: Identification of risk factors associated with incident myopia at 1 and 2 years in eyes of young pre-myopic children. METHODS: 150 eyes of 75 placebo-treated pre-myopic children (spherical equivalent (SER) -0.49 to +1.0D) from the Atropine Treatment of Myopia (ATOM3) study were analysed. Cycloplegic SER and axial length (AL) were assessed at 6 month intervals. Univariate and multivariate logistic analyses were used to study associations between myopia incidence and demographic factors, SER, AL, parental myopia and lifestyle factors. Generalised estimating equations (GEE) were used to account for clustering of eyes. RESULTS: 35 (23%) and 59 (39%) eyes became myopic by 1 and 2 years, respectively, with 91 (60%) remaining emmetropic. 74% of eyes with SER of -0.49 to 0.01D became myopic within 1 year. In eyes with SER of 0 to +0.50D, 32% and 55% became myopic at 1 and 2 years, respectively; while only 13% with SER>+0.5D became myopic at 2 years. Myopia progression was greater 6 months prior to myopia onset in eyes becoming myopic (-0.73±0.39D or 0.34±0.15 mm) compared with eyes remaining emmetropic (-0.17±0.28D or 0.13±0.08 mm). Myopia progressions of >0.3 mm or -0.5D within the first year showed the best sensitivity-specificity balance in predicting myopia onset over 1-2 years. No associations were noted with baseline AL, parental myopia, books read and time outdoors. CONCLUSION: Eyes of children aged 5-9 years with a cycloplegic SER <±0.5D and myopic shift more/equal to 0.30 mm or -0.5D within the first year were at higher risk of becoming myopic within the next 2 years.
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